Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 14323 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 14323 | TX |
NPI | 1083245336 |
---|---|
Provider Name | Dr. Shelby Marie Elder |
First Address | Plano, TX 75093-7993 |
Second Address | Plano, TX 75093-7993 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2020 |
Last Update Date | 27/01/2020 |